The Institute of Medicine recently issued a report calling for improvements in the quality of cancer prevention services. Colorectal cancer is the third leading cause of cancer-related mortality. Colorectal cancer screening could substantially reduce the morbidity and mortality of this disease, yet screening rates are surprisingly low. Insurance coverage and the management practices of health plans may be critical factors if we are to increase screening rates. We propose to analyze data from two national survey samples and to develop a new survey of health plan medical directors to examine insurance coverage and managed care as determinants of colorectal cancer screening. The specific aims of the study are: (1) Using national data from the Behavioral Risk Factor Surveillance System (BRFSS), we will assess rates of colorectal cancer screening before and after the Medicare program instituted first-dollar insurance coverage for colorectal cancer screening in 1998; (2) Using the Medicare Current Beneficiary Survey (MCBS), we will assess whether colorectal cancer screening rates are higher among Medicare beneficiaries enrolled in managed care health plans compared to those with fee-for-service insurance controlling for other confounding factors. Additionally, we will examine whether disparities in colorectal cancer screening rates for socioeconomic minorities are smaller for managed care enrollees than for others; (3) Using structured interviews of health plan medical directors, we will evaluate and compare the quality management programs of health plans that have high colorectal cancer screening rates and those with lower rates. Results of this study can guide the enactment of health policies that will increase rates of colorectal cancer screening and thereby reduce the incidence of colorectal cancer and its associated morbidity and mortality.